2015年-世界发展银行全球_Accelerating_Health_Equity___The_Key_Role_of_Universal_Health_Coverage_in_the_Sustainable_Development_Goals_5页_1020kb

Summary of "Accelerating health equity: the key role of universal health coverage in the Sustainable Development Goals"

Core Content

This document explores the role of Universal Health Coverage (UHC) in achieving health equity as part of the Sustainable Development Goals (SDGs). It emphasizes the importance of government investment, health system strengthening, and health workforce development in ensuring equitable access to health services and reducing disparities in health outcomes.

The SDGs represent a more ambitious and comprehensive set of health-related targets compared to the Millennium Development Goals (MDGs). The document highlights that many MDG off-track countries struggle with providing and sustaining financial access to quality health services, especially for the poor. UHC is identified as a critical component of the SDGs, aiming to provide financial protection against catastrophic health expenditures and access to essential services.

Main Viewpoints

• UHC as a Key SDG Target: UHC is a central health goal within the SDGs and is seen as both a measurable objective and a means to achieve other health targets. It is also a major focus of the global agenda, as seen in the 2012 UN General Assembly Resolution.

• Trajectories to UHC: Countries adopt various strategies to achieve UHC, often influenced by socio-economic and political contexts. These include:

  • Contributory schemes (e.g., social health insurance) for public and private sector employees.
  • Tax-financed mechanisms for the poor, as implemented in Vietnam and the Philippines.
  • Free public services in some countries, which can lead to high out-of-pocket payments if not supported by sufficient public spending.
  • High cost public services in the Pacific Island States, which reduce out-of-pocket payments.

• Health Equity and UHC: UHC is closely linked to health equity. Improving geographical and financial access to health services is essential. For instance, skilled birth attendance (SBA) is a strong indicator of health equity, with higher coverage reducing rich-poor disparities. In Thailand, achieving universal coverage of Maternal and Child Health (MCH) services led to significant reductions in child mortality inequalities.

• Health Workforce Challenges: A shortage and uneven distribution of the health workforce are major obstacles in achieving UHC, particularly in low-income countries. Despite the Kampala Declaration and other commitments, investment in health workforce remains low, and retention in rural areas is a persistent challenge. The International Labour Organization (ILO) estimates that 10.3 million additional health workers are needed globally, with 7.1 million in Asia and 2.8 million in Africa.

• Global Migration of Health Workers: High-income countries, especially OECD members, are major destinations for health workforce migration, often from low and middle-income countries. This is driven by aging populations and the need for long-term care, but also by push factors such as low pay, lack of career development, and poor working conditions. The WHO Global Code of Practice on international recruitment has not been fully implemented.

• Fiscal Space for UHC: Achieving UHC requires increased public investment. Countries need to systematically review opportunities for fiscal space creation, including tax reforms, international aid, and efficiency gains. The Philippines has successfully increased health funding through a sin tax reform. The UK has reaffirmed its commitment to 0.7% of GDP for overseas development assistance, with a call for 0.15% to be allocated to health.

Key Information

• SDG3 includes 13 targets, including reducing maternal mortality, ending preventable child deaths, and achieving UHC.
• UHC involves financial protection and access to essential services, and is essential for health equity.
• Primary Health Care (PHC) is a critical component in translating UHC policies into pro-poor outcomes.
• Fiscal space is a key enabler for UHC, with tax reforms and international aid being important sources.
• Health workforce planning, retention, and education are vital for UHC and health equity.
• Cross-sectoral collaboration is necessary to ensure health considerations are integrated into other policies.

Conclusion

UHC and a strong health workforce are essential for achieving the SDGs and health equity. The document stresses that political commitment, effective policies, and sufficient public investment are necessary to realize UHC and its associated benefits. It calls for systematic reviews of fiscal space, improved health workforce planning, and stronger implementation of international health recruitment codes to ensure equitable and sustainable health systems.

References

• The SDGs are the result of the largest UN consultation process.
• UHC is linked to financial protection and access to essential services.
• Thailand serves as a successful example of UHC implementation.
• ILO projects a global need for 10.3 million additional health workers.
• Tax reforms and international aid are important for fiscal space.
• Health workforce challenges include shortages, maldistribution, and retention issues.
• Cross-sectoral policies are essential for health equity and system strengthening.